Impact of long-term combination lipid-lowering therapy on plaque vulnerability in patients with acute coronary syndrome
Abstract
Aim. To evaluate the potential of high-dose combination lipid-lowering therapy (LLT) in reducing coronary atherosclerosis in patients after acute coronary syndrome (ACS), depending on the presence of vulnerable plaques (VPs). Material and methods . The study included 125 patients (men, 68%; mean age, 56,9±9,8 years) after ACS and percutaneous coronary intervention. After one month of treatment, coronary computed tomography angiography (CCTA) was performed, and the patients were randomized into two groups depending on VP presence. After 12 months, a repeat CCTA was performed during LLT. Results. Combined LLT resulted in a significant decrease in VP criteria as follows: Me (Q 1 ;Q 3 ), 2 (1;4) vs 2 (1;2), p=0,002. In the group of patients with VP, the prevalence of atherosclerosis in the following coronary arteries was significantly reduced: the left main coronary artery (p=0,008), the left anterior descending artery (p=0,002), and the circumflex artery (p=0,016). A significant decrease in the SSS and SIS scales was also noted between visits 2 and 6 in the group with VP — Me (Q 1 ;Q 3 ), 3 (1;4) vs 2 (1;4), p<0,001. The coronary calcium index in the group with VP was higher than in the group without VP both at visit 2: Me (Q 1 ;Q 3 ), 35 (1;138) vs 111 (29;247), p=0,004, and at visit 6: Me (Q 1 ;Q 3 ), 35 (0;178) vs 105 (31;245), p=0,008. After 1-year therapy, a significant decrease in the level of total cholesterol (p<0,001), low-density lipoproteins (p<0,001) and triglycerides (p<0,001 vs p=0,002) was noted in each group without a negative effect on safety markers. Within each group, characteristic signs of a decrease in lipid levels were recorded between visits 2 and 6, while no indicators were detected in the intergroup comparison of these indicators at visits 2 and 6. Conclusion . Combined LLT after ACS leads to a significant reduction in the severity of coronary atherosclerosis, as measured by CCTA and SIS and SSS scales, due to VP stabilization.